Defining Autism Spectrum Disorders
What Is Autism?
Autism is a complex neurobehavioral disorder characterized by impairment in reciprocal social interaction, impairment in communication, and the presence of repetitive and stereotypic patterns of behaviors, interests, and activities. The onset of symptoms is typically before the age of 3 years. The severity of impairment in the given domains as well as the pattern of impairments varies from individual to individual that is why diagnosticians refer to a spectrum of disability.
Impairment in social interaction range from difficulty initiating and maintaining interaction, impaired ability to recognize and experience emotions, and difficulty processing and appreciating the thoughts and feelings of others. Communication deficits range from no useful form of communication to very advanced language abilities, but little ability to use language in a social manner. Repetitive and stereotypic behaviors include perseverative behaviors such as complex rituals, extreme difficulty adapting to change and transition, and unusual movements such as hand flapping or whirling.
Once thought to be very rare, autism spectrum disorders are estimated to occur in as many as 1: 59 .
Some People Use Other Names For Autism
There are other names for autism used by some people, such as:
- autism spectrum disorder the medical name for autism
- autism spectrum condition used instead of ASD by some people
- Asperger’s used by some people to describe autistic people with average or above average intelligence
Unlike some people with autism, people with Asperger’s do not have a learning disability.
Some people call this “high-functioning” autism.
Doctors do not diagnose people with Asperger’s anymore.
But if you were diagnosed with it before, this will stay as your diagnosis.
What Are The 3 Main Symptoms Of Autism
Autism or autistic spectrum disorder can manifest as different symptoms in different children. The average age of diagnosis is 2 years, though some children may be detected at around the age of 5 years.
The symptoms to look out for in children for suspected autism are:
- Delayed milestones
- A socially awkward child
- The child who has trouble with verbal and nonverbal communication
Delayed Milestones: Every child starts cooing, rolling over, babbling, smiling, pointing, and sitting up at an expected age. These are called milestones. Though every child grows at their own pace, you must visit the pediatrician if:
- The child does not smile by the age of 6 months
- The child has no facial expressions by the age of 9 months
- The child does not make cooing noises or babble by the age of 12 months
- No pointing or waving by the age of 12 months
- The child does not speak by the age of 16 months
Signs of social awkwardness: You must be concerned if your child
- Avoids eye contact while you feed him
- Prefers to play alone
- Does not respond to their name
- Does not like being touched
- Prefers fixed routines and even a minor change may upset them greatly
- Has trouble understanding feelings or talking about them
Problems with verbal and nonverbal communication:
- Echolalia: They keep repeating words over and over
- They talk in a flat tone, devoid of expressions
- They do not understand emotions in a conversation
- Have difficulty communicating what they want
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Restrictive / Repetitive Behaviors May Include:
- Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
- Having a lasting intense interest in certain topics, such as numbers, details, or facts
- Having overly focused interests, such as with moving objects or parts of objects
- Getting upset by slight changes in a routine
- Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:
- Being able to learn things in detail and remember information for long periods of time
- Being strong visual and auditory learners
- Excelling in math, science, music, or art
How Common Is Autism Spectrum Disorder
Based on most recent CDC report, ASD is estimated to affect about 1 in 54 children, with boys being more likely to have ASD than girls. There were more than 5 million adults in the US, or 2.21% of the population, with ASD as of 2017. Government statistics suggest that the prevalence of ASD has risen 10% to 17% in recent years.
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The Facts About Autism And Common Misconceptions
Are you finding that well-meaning family and friends, media commentators even some health professionals are making you more concerned and confused about your own or your childs autism or suspected autism?
Misinformation and mixed messages can lead to feelings of guilt and isolation and can work against a proactive diagnosis and support program. Although the global understanding of autism is constantly evolving, here are some of the commonly understood facts, to help you put some of these misconceptions about autism to bed.
Explaining Autism In Simple Terms
In simple terms, autism occurs when a child has trouble communicating and understanding what people think and feel. This makes it very difficult for autistic children to respond to gestures, facial expressions, touch and even language.
Autism Spectrum Disorder could lead to varying degrees of impairment in the patient ranging from mild or high functioning autism to the classical or severe autism.
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Autism Is Not An Illness
Being autistic does not mean you have an illness or disease. It means your brain works in a different way from other people.
It’s something you’re born with or first appears when you’re very young.
If you’re autistic, you’re autistic your whole life.
Autism is not a medical condition with treatments or a “cure”. But some people need support to help them with certain things.
How Is Autism Diagnosed
Doctors check babies and little kids for signs of autism at every checkup. A parent may think that something is wrong and tell the doctor. Maybe the child is old enough to speak but doesn’t. Or a kid doesn’t seem interested in people or plays in unusual ways.
When a doctor thinks a kid might have autism, he or she will work with a team of experts to see if it is autism or something else.
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National Autism Society Key Autism Traits Checklist In Adults Description
- Do you struggle in social situations?
- Do you dislike or are uncomfortable with change?
- Are you accused of staring blankly at something?
- Do you not understand facial gestures of people around you?
- Do people tell you that you speak too soft or too loud?
- Do you always feel wired have to be on the go?
- Are you dyslexic or have epilepsy?
- Is it hard for you to read peoples thoughts through their actions?
- Do you find it easy to live by rules and follow routines?
- Do you have a hard time filtering out background noise, lighting or smells?
There are many tests that can be administered by a psychologist, psychiatrist or neurologist. In most cases, you will need a referral from your general physician. Go through the checklist and the autism evaluation tests, present the finding to your general physician who will then, if required, refer you to one of the specialists for further testing and assessment.
Level : Requiring Support
A person who meets the criteria for level 1 may face social challenges that require some support.
They may find it difficult to:
- initiate conversations with others
- respond as others would expect
- maintain interest in the conversation
As a result, it can be hard to make friends, especially without the right support.
The person may also:
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Problems With Communication And Social Interaction
These can include:
- issues with communication, including difficulties sharing emotions, sharing interests, or maintaining a back-and-forth conversation
- issues with nonspeaking communication, such as trouble maintaining eye contact or reading body language
- difficulties developing and maintaining relationships
Treatment Modes And Modalities
Treatment modes and modalities are technologies or other support systems that the SLP can use in conjunction with, or during implementation of, various treatments. For example, the SLP can use video-based instruction in peer-mediated interventions to address social skills and other target behaviors.
A number of treatment modes and modalities are described below. When selecting a mode or modality, the SLP considers the intervention goal and the individual’s developmental stage. For example, a mode or modality that is appropriate for an individual who is at the emerging language stage may not be appropriate for an individual who is at the prelinguistic stage. The list below is not exhaustive, and inclusion does not imply an endorsement from ASHA.
An AAC system is an integrated group of componentsâincluding symbols, selection techniques, and strategiesâused to enhance communication. AAC uses a variety of techniques and toolsâincluding picture communication systems, line drawings, photographs, video clips, speech-generating devices , tangible objects, manual signs, gestures, and finger spellingâto help the individual express thoughts, ideas, wants, needs, and feelings. AAC can be used to supplement existing expressive verbal communication or with individuals who are unsuccessful at learning expressive verbal communication.
Activity Schedule and Visual Supports
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Getting Evaluated For Autism Spectrum Disorder
Parent interview In the first phase of the diagnostic evaluation, you will give your doctor background information about your childs medical, developmental, and behavioral history. If you have been keeping a journal or taking notes on anything thats concerned you, share that information. The doctor will also want to know about your familys medical and mental health history.
Medical exam The medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. Your child will undergo this full screening to determine the cause of their developmental problems and to identify any co-existing conditions.
Hearing test Since hearing problems can result in social and language delays, they need to be excluded before an Autism Spectrum Disorder can be diagnosed. Your child will undergo a formal audiological assessment where they are tested for any hearing impairments, as well as any other hearing issues or sound sensitivities that sometimes co-occur with autism.
Observation Developmental specialists will observe your child in a variety of settings to look for unusual behavior associated with the Autism Spectrum Disorder. They may watch your child playing or interacting with other people.
Lead screening Because lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children with developmental delays be screened for lead poisoning.
What Should I Do If My Child Has Delayed Milestones
Talk to your child specialist about your concerns. While it is absolutely normal for every child to achieve milestones at their own pace, you must always be on the lookout for red flags. If the child does not smile, coo, speak, react to your affections by hugging back, or have eye contact, you must consult your doctor.
You must specifically monitor your childs growth and development if
- You were on medications like Thalidomide, Valproic acid, or antipsychotic medicines during your pregnancy.
- You or your spouse was in late the 30s when you conceived .
- You have a family member with autism.
- You suffered from viral infections during your pregnancy.
- Your baby had a low birth weight.
Wait and watch policy will not help a child with an autistic spectrum disorder. In fact, from 1 to 2 years of age, the brain is still developing. If the therapy is started at this point, most symptoms of autism can be worked upon. Though, currently, autism is not curable, early intervention during the preschool years can help the child manage the behavioral issues and teach them to cope better in social situations. Behavioral therapy involves teaching parents to reach out to their children. Children suffering from hyperactivity, convulsions, and sleep problems also need early medical management.
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Highly Focused Interests Or Hobbies
Many autistic people have intense and highly focused interests, often from a fairly young age. These can change over time or be lifelong. Autistic people can become experts in their special interests and often like to share their knowledge. A stereotypical example is trains but that is one of many. Greta Thunberg’s intense interest, for example, is protecting the environment.
Like all people, autistic people gain huge amounts of pleasure from pursuing their interests and see them as fundamental to their wellbeing and happiness.
Being highly focused helps many autistic people do well academically and in the workplace but they can also become so engrossed in particular topics or activities that they neglect other aspects of their lives.
Take a look at the Spectrum magazine, written for and by autistic people
Causes And Risk Factors
We do not know all of the causes of ASD. However, we have learned that there are likely many causes for multiple types of ASD. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors.
- Most scientists agree that genes are one of the risk factors that can make a person more likely to develop ASD.4, 19
- Children who have a sibling with ASD are at a higher risk of also having ASD. 5-10
- Individuals with certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis, can have a greater chance of having ASD. 11-14, 20
- When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASD.15-16
- There is some evidence that the critical period for developing ASD occurs before, during, and immediately after birth. 17
- Children born to older parents are at greater risk for having ASD. 18
ASD continues to be an important public health concern. Like the many families living with ASD, CDC wants to find out what causes the disorder. Understanding the factors that make a person more likely to develop ASD will help us learn more about the causes. We are currently working on one of the largest U.S. studies to date, called Study to Explore Early Development . SEED is looking at many possible risk factors for ASD, including genetic, environmental, pregnancy, and behavioral factors.
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A Short History Of Autism
Researchers have been working on autism and autism-like disorders since the 1940s. At that time, autism studies tended to be small in scale and used varying definitions of the disorder. Autism was also sometimes lumped in with other conditions.
Focused research into ASD became more common in the 1980s when the DSM-III established autism as a distinct diagnosis. Since then, researchers have explored the causes, symptoms, comorbidities, efficacy of treatments, and many other issues related to autism.
Researchers have yet to discover a cause for autism. Many of the ideas put forth thus far have been disproven. Likely a combination of genetic, neurological, and environmental factors are at work, which is the case with many psychiatric disorders and conditions.
Diagnosing Autism Spectrum Disorder
In order to determine whether your child has autism spectrum disorder or another developmental condition, clinicians look carefully at the way your child interacts with others, communicates, and behaves. Diagnosis is based on the patterns of behavior that are revealed.
If you are concerned that your child has autism spectrum disorder and developmental screening confirms the risk, ask your family doctor or pediatrician to refer you immediately to an autism specialist or team of specialists for a comprehensive evaluation. Since the diagnosis of autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area.
The team of specialists involved in diagnosing your child may include:
Diagnosing Autism Spectrum Disorder is not a brief process. There is no single medical test that can diagnose it definitively instead, in order to accurately pinpoint your childs problem, multiple evaluations and tests may be necessary.
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Autism And Assistive Technology
Technology has recently given some children with severe autism ways to communicate. Assistive technology is any product, item, or piece of equipment that is used by a person with a disability to perform tasks, improve functional capabilities, and become more independent. The assistive technology may be a computer tablet, a computer, or even a phone app with programs especially designed to engage children with autism. For students with severe communication difficulties, a device with a speech-generating app or a speech generating device may be highly effective.
How Is The Brain Affected By Autism Spectrum Disorder
Children affected by autism have an excess of synapses, or connections between brain cells. This is because there is a shutdown in the normal pruning process that occurs during brain development. A typical pruning process involves eliminating about half of cortical synapses by late adolescence. Cortical synapses occur in the cortex, which is central to thought and processing information from the senses.
Some children with autism have larger than normal brains but findings are inconsistent. MRI scans of some children with autism show abnormal cortical responses and some show other abnormalities. Future advances in brain studies may change our understanding of the brain’s role in autism.
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Cultural And Linguistic Considerations
Awareness of individual and cultural differences is essential for accurate diagnosis. For example, direct eye contact with an authority figure may be considered disrespectful in some cultures, and silence may be valued as a sign of respect. In a U.S. school system, these behaviors could easily be misinterpreted as socially inappropriate.
The core characteristics of ASD may be viewed through a cultural lens leading to under-, over-, or misdiagnosis . Signs and symptoms that are clearly “red flags” in the U.S. health care or educational system may not be viewed in the same way by someone from a culture that does not formally define the disorder.
Cultural and linguistic variables may contribute to the disparity in the diagnosis of ASD among some racial/ethnic groups . For example, Begeer et al. found that Dutch pediatricians might be inclined to attribute social and communication problems of non-European minority groups to their ethnic origin, while attributing these same characteristics to autistic disorders in children from majority groups.